Ontario Temporary Health Program for Refugee Claimants

Notice: On April 1, 2016 the federal government will be fully restoring the Interim Federal Health Program (IHFP). As such, the Ontario Temporary Health Program (OTHP) will not be extended beyond its scheduled March 31, 2016 program end date. Health care providers must submit claims for payment under the OTHP to Medavie Blue Cross within eight months of the date the service was provided. For services provided on March 31, 2016, the last date to submit claims would be November 30, 2016.

Background

On January 1, 2014, the Ontario Ministry of Health and Long-Term Care launched the Ontario Temporary Health Program (OTHP) for refugee claimants.

The Ontario Temporary Health Program was created to address gaps in health care coverage for refugee claimants and rejected refugee claimants created by the downscaling of the Interim Federal Health Program (IFHP).

This consent-based program will provide eligible claimants short-term essential and urgent health care coverage for most services received in a hospital, primary and specialist care, laboratory and diagnostic services provided in Ontario, as well as some medications equivalent to the Ontario Drug Benefit (ODB) formulary.

OTHP is an independent program administered by a third party provider, Medavie Blue Cross, and coverage will be available to eligible refugee claimants for many services no longer covered through the Interim Federal Health Program or other Ontario programs.

Information for health-care professionals

You must obtain written consent, by having the patient sign the OTHP Consent Form or contacting Medavie Blue Cross to determine if consent has already been documented.

You must determine if the patient visit is beyond the three month wait period required for coverage. Exemptions include :

Children under the age of 18

Women requiring perinatal and prenatal care

Individuals who have a life-threatening medical condition requiring immediate medical attention, in the opinion of a physician practicing medicine in Ontario

You must verify at each visit that a patient is eligible for OTHP with Medavie Blue Cross as a person may cease to be eligible or have their coverage changed at any time.

You must ask patients if they are eligible for any other private health insurance program or plan that covers the service or product. If the patient has another plan or program, you cannot be reimbursed by the OTHP.

You must not charge beneficiaries for services or products covered under the OTHP. You must directly bill the OTHP through Medavie Blue Cross.

In Ontario, OTHP enforces the lowest cost alternative rule and reimburses at the cost of available equivalent generic preparations.

For claims to qualify for the OTHP, they must be submitted first for processing to Medavie Blue Cross through the IFHP. If the claim is rejected for services beyond Public Health and Public Safety coverage under IFHP, it can be sent to the OTHP for consideration of payment.

To send to OTHP for payment, all of the following must be submitted :

Completed and signed OTHP Client Consent Form. Consent forms can be obtained by contacting Medavie Blue Cross at 1-888-614-1880 or visiting the Medavie Blue Cross and selecting the Health Professionals link.

A photocopy of the signed IFHP Claim Form. Clearly indicate on the claim form that you are submitting it to OTHP.

Explanation of Benefits (Payment Statement) from Medavie Blue Cross that explains the reason for the claim's rejection under IFHP.

A photocopy of the Claimant Interim Federal Health Certificate of Eligibility (IFHC) or the Refugee Protection Claimant Document (RPCD). Without the certificate, the client's eligibility cannot be verified and the claim will not be processed.

All claims must be submitted for payment to Medavie Blue Cross within eight months of the date the service was provided. Claims exceeding eight months will be rejected. Claims for services dated prior to January 1, 2014, will not be eligible for reimbursement.

For more information on claims submission and processing contact Medavie Blue Cross at 1-888-614-1880.